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Received: 29 March 2017 Revised: 14 January 2018 Accepted: 5 June 2018 DOI: 10.1111/jasp.12533
ORIGINAL ARTICLE
Does functional diversity increase effectiveness of community care teams? The moderating role of shared vision, interaction frequency, and team reflexivity Joep Hofhuis1,2
| Monique Mensen3 | Lydia M. ten Den2 |
Annemieke M. van den Berg3 | Marieke Koopman‐Draijer3 | Marianne C. van Tilburg3 | Carolien H. M. Smits3 | Sjiera de Vries2 1 Erasmus Research Center for Media, Communication and Culture (ERMeCC), Erasmus University Rotterdam 2
Abstract As interprofessional collaboration becomes more commonplace in health and social
Research Group Social Innovation, Windesheim University of Applied Sciences
care, both scholars and practitioners are searching for ways to make the most out of
3
functional backgrounds may lead teams to perform better, because they have a larger
Research Group Innovating with Older Adults, Windesheim University of Applied Sciences Correspondence Joep Hofhuis, Department of Media and Communication, Erasmus University Rotterdam, Erasmus Research Center for Media, Communication, and Culture (ERMeCC), P.O. Box 1738, 3000 DR Rotterdam, the Netherlands. Email:
[email protected] Funding information Dutch Taskforce for Applied Research [Nationaal Regieorgaan Praktijkgericht Onderzoek SIA], Grant/Award Number: Raak Publiek 2014-01-13M
functionally diverse teams. Earlier research has shown that the presence of different pool of knowledge and experience to draw from. Other studies show, however, that functional diversity increases categorization, reduces team cohesion, and complicates interpersonal communication, thereby reducing performance. It remains unclear under which conditions positive or negative outcomes may occur. The present research tested the influence of functional diversity on team identity, team performance, and client satisfaction, and examined factors which may moderate these relationships. Based on earlier studies in this specific context, we focused on three team processes as possible moderators: shared vision, interaction frequency, and team reflexivity. In a survey among health and social care professionals working in community care teams in the Netherlands (n = 167), all three are shown to moderate the relationship between functional diversity and team effectiveness. In the absence of these processes, functional diversity appears to reduce team outcomes, whereas when these processes are present, the relationships are positive. In sum, in order for community care teams to reap the benefits of functional diversity, it is essential that members develop a shared vision, interact frequently, and practice team reflexivity. KEYWORDS
community care, functional diversity, interprofessional collaboration, shared vision, team identity, team performance, team reflexivity
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2018 The Authors. Journal of Applied Social Psychology published by Wiley Periodicals, Inc. J Appl Soc Psychol. 2018;1–14.
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1 | I NTRO D U C TI O N
(De Dreu & West, 2001; Hofhuis, Van der Rijt, & Vlug, 2016; Nijstad & De Dreu, 2017; West, 2002).
Interprofessional collaboration has become a high priority for health
However, the CEM also poses that the positive effects of diver-
and social care professionals around the globe (WHO, 2010). For ex-
sity on team functioning are moderated by categorization: the ten-
ample, in the Netherlands, a shift in government policies has increased
dency of individuals to cognitively organize their social environment
the need for locally organized community care teams, in which pro-
into groups (Tajfel & Turner, 1986; Turner, 1985). When individuals
fessionals from different functional backgrounds work together. The
identify with a social in‐group, this is usually done on the basis of
aim of such teams is to raise client satisfaction in community care,
shared characteristics. Individuals who are different are categorized
while simultaneously increasing cost‐effectiveness (Rutte & Samsom,
as belonging to an out‐group. This categorization helps individuals to
2012; Ten Den, Hofhuis, & De Vries, 2015). Existing research shows
predict and give meaning to their social environment. The downside
that teams in which professionals with different functional back-
of social categorization is that it leads to the emergence of stereo-
grounds collaborate, may indeed be more effective than functionally
types and group representations that tend to favor the in‐group over
homogenous teams. The presence of different experiences and view-
the out‐group (Brewer & Brown, 1998; Fiske, 1998). This, in turn,
points may make the group as a whole more flexible and innovative
has a negative impact on interpersonal communication between
(De Dreu & West, 2001; Tekleab, Karaca, Quigley, & Tsang, 2016; Van
team members (Woehr et al., 2013), reduces job satisfaction and
Knippenberg, De Dreu, & Homan, 2004). On the other hand, however,
may increase turnover intent (Hofhuis, Van der Zee, & Otten, 2014).
functional diversity may also hinder collaboration, e.g., by increasing
As a result, categorization processes and the resulting negative in-
the risk of miscommunication and conflict between team members,
fluence on social interactions may reduce team performance (Van
or by reducing team cohesion (Mitchell, Parker, & Giles, 2011; Pelled,
Knippenberg et al., 2004).
Eisenhardt, & Xin, 1999; Woehr, Arciniega, & Poling, 2013).
The above‐mentioned effects of diversity on team effectiveness,
A review of the literature on interprofessional collaboration
both positive, through elaboration, as well as negative, through cat-
reveals several team processes which may increase effectiveness
egorization, have been established for different types of diversity,
of functionally diverse care teams (D’Amour, Ferrada‐Videla, San
and in different contexts and settings (Guillaume, Dawson, Otaye‐
Martin Rodriguez, & Beaulieu, 2005; Fay, Borrill, Amir, Haward, &
Ebede, Woods, & West, 2017; Schippers, West, & Dawson, 2015).
West, 2006; Xyrichis & Lowton, 2008). However, empirical stud-
In the present study, we focus specifically on functional diversity,
ies that systematically compare how these variables moderate the
which we define as the presence of employees with different func-
diversity‐effectiveness link, especially within the context of health
tional and/or educational backgrounds within a single work group.
and social care, remain scarce (Supper et al., 2015). In this paper, we
The body of research that specifically deals with functional diversity
present a quantitative field study which examines the influence of
is smaller than that focusing on cultural, ethnic, or gender diversity
functional diversity on the effectiveness of community care teams,
but those studies that link functional diversity to workgroup per-
and the moderating role of three team process variables: shared vi-
formance report similar findings, and confirm the applicability of
sion, interaction frequency, and team reflexivity.
CEM to this domain (Bell, 2007; Gebert, Boerner, & Kearney, 2006; Tekleab et al., 2016; Van Dijk, Van Engen, & Van Knippenberg, 2012).
1.1 | Outcomes of functional diversity in teams In recent decades, the effects of diversity on team performance have been widely studied, revealing inconsistent results: depending on context and conditions, diversity may display a positive, negative
1.2 | Moderators of the functional diversity‐effectiveness link The apparent paradox in findings suggests that the effects of func-
or no relationship to performance (Hofhuis, van der Zee, & Otten,
tional diversity on team outcomes may be contingent on other varia-
2015; Van Knippenberg & Schippers, 2007; Williams & O’Reilly,
bles. The CEM (Van Knippenberg et al., 2004) itself mentions several
1998). The most commonly used framework for explaining the ambi-
conditions which enable both the categorization as well as the elabo-
guities in research findings is the Categorization‐Elaboration Model
ration paths toward diversity outcomes. For the categorization path,
(CEM; Van Knippenberg et al., 2004). It poses that the advantages
the CEM proposes that social categories must be cognitively acces-
and disadvantages of diversity for teams are caused by two inde-
sible, and that a threat to the in‐group will enhance categorization.
pendent but interacting paths.
Other scholars point out that attitudes toward diversity play a role
Firstly, the main selling point of diversity is that it may enhance
in in‐group bias (Hofhuis, Van der Zee, & Otten, 2016), or the rela-
effectiveness of work groups, because the greater pool of available
tionship between diversity and team identity (Luijters, Van der Zee,
knowledge and experiences facilitates elaboration of task‐relevant in-
& Otten, 2008; Van Dick, Van Knippenberg, Haegele, Guillaume, &
formation. Expression of divergent ideas and opinions may force team
Brodbeck, 2008).
members to be more alert and critical in their evaluation of prob-
The CEM also mentions moderators of the elaboration path. For
lem‐solving strategies (Brodbeck & Greitemeyer, 2000; Collins &
example, it states that the process of elaboration is only relevant in
Geutzkow, 1964). This, in turn, may result in a reduced risk of group-
teams in which members possess the motivation and ability to dis-
think, more effective decision‐making, and higher team performance
cuss task‐relevant information. Other scholars have shown that the
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HOFHUIS et al.
positive effect of information elaboration is limited to teams with
professionals allows them to blend complementary knowledge,
high task complexity (Van Dijk et al., 2012). Hofhuis, van der Rijt, and
competences, and skills to make best use of available resources
Vlug (2016) extend this by showing that positive diversity beliefs may
(D’Amour et al., 2005; Supper et al., 2015). Earlier studies have
also affect the elaboration path, through enhanced knowledge shar-
provided evidence for the increased effectiveness of interprofes-
ing between team members. For an extensive overview of constructs
sional teams over functionally homogenous teams in this sector. For
which have been established to moderate the diversity‐effectiveness
instance, one study reports that interprofessional cooperation be-
link, see a recent review by Guillaume and colleagues (2017).
tween physicians reduces hospitalization cost and readmission rates
In an earlier meta‐analysis on the role of context in diversity
(Uddin, Hossain, & Kelaher, 2012), whereas another found support
research, Joshi and Roh (2009) report that relationships and mod-
for the hypothesis that interprofessional collaboration increases in-
erators that are found in one type of setting or team do not automat-
novation among health care workers in hospital teams (Fay et al.,
ically translate to another. The specific characteristics of the task,
2006). A narrower review which focuses specifically on the litera-
the profession or the industry, have a profound influence on how
ture on functional diversity in community care teams, confirms that
functional diversity manifests itself, and which moderators apply.
under the right circumstances, interprofessional collaboration is an
The goal of the present paper is to specifically zoom in on health
efficient and productive way of achieving goals and results (Xyrichis
and social care professionals in community care teams, and examine
& Lowton, 2008).
whether, and under which conditions, functional diversity relates to
The authors of the latter review also report, however, that func-
team effectiveness in this specific context. Below we will first out-
tional diversity does not automatically increase effectiveness of care
line the setting in which this study took place.
teams. In fact, in many studies, nonsignificant or even negative effects are reported (D’Amour et al., 2005; Gebert et al., 2006; Kozlowski & Ilgen, 2006; Supper et al., 2015; Xyrichis & Lowton, 2008). These
1.3 | Functional diversity in community care teams
findings may be explained through the categorization path of the CEM (Van Knippenberg et al., 2004). When team members identify
Since 2015, the Netherlands’ Government has actively encouraged
strongly with their own profession, feelings of inclusion, and cohesion
the formation of locally organized care teams, consisting of members
within the interprofessional team may be reduced, which results in
of different functional groups in health and social care, such as com-
lower team identity (Mitchell et al., 2011). This, in turn, has been as-
munity nurses, social workers, general health practitioners, physi-
sociated with lower performance, less job satisfaction and increased
otherapists, psychologists, job coaches, and youth counselors. The
turnover (Allen & Meyer, 1990; Hofhuis, Van der Zee, & Otten, 2012;
aim of these newly formed teams is to provide a single access point
Tekleab et al., 2016). Another possible explanation for these findings is
for community members in need, improving the sense of cohesion
that each profession develops strong theoretical and function‐based
within the community, as well as increasing effectiveness of the pro-
frameworks that form the professionals’ attitudes, norms, and values
vided care (Rutte & Samsom, 2012). It is important to note that the
toward the job. Interprofessional collaboration thus entails working
health and social care professionals generally remain employed by an
together with colleagues with different value systems and/or work
overarching organization rooted in their functional discipline. For ex-
ethics (Brown, 2002; D’Amour et al., 2005). Studies that have inquired
ample, each region will have a number of community nursing organi-
into the effects of differences in values or cognitive schemas, termed
zations, who assign their employees to work within one or more of the
deep‐level diversity, generally report a negative relationship with
local community teams. Simultaneously, organizations in other disci-
team cohesion and effectiveness (Bell, 2007; Mello & Rentsch, 2015).
plines, such as the regional providers of social work, will also assign
In sum, existing literature shows that the CEM is able to explain
their employees to these teams. The size and exact composition of
the effects of functional diversity on performance in community care
the community care teams are flexible and demand‐driven; they de-
teams: both elaboration and categorization processes may occur,
pend on the characteristics of the community, such as the percentage
depending on the characteristics of the team. In the present study,
of elderly inhabitants, the number of schools within the community,
we investigate possible moderators of these processes, to establish
social–economic conditions, etc. The system results in a patchwork
under which conditions these teams may function most effectively.
of different community care teams around the country, with a myriad
However, before examining possible moderators, it is important to
of different functional disciplines represented within the team. It is
first establish what constitutes team effectiveness in this context.
important to note that the daily work of members of these teams is highly complex; they deal with many different clients, with many different and often co‐occurring needs, and engage in both social‐ and
1.4 | Effectiveness of community care teams
healthcare related tasks. Problem‐solving and effective interprofes-
Based on existing literature, the present study employs three distinct
sional communication thus are essential skills for working success-
outcome measures that have been shown to relate to care teams’ abil-
fully in this dynamic environment (D’Amour et al., 2005).
ity to reach goals (Cole, Waite, & Nichols, 2004; Supper et al., 2015;
The concept of information elaboration, as explained above, is
Suter, Oelke, Adair, & Armitage, 2009). Firstly, team identity, is defined
also the drive behind these changes in community care practices.
as the degree to which professionals identify with their interprofes-
The integrative cooperation of different health and/or social care
sional team, and experience a sense of cohesion. Team identity has
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HOFHUIS et al.
4
been shown to be an important predictor of team effectiveness, and
opportunities for information elaboration, thus reducing team
also relates strongly to affective job evaluations, such as job satis-
effectiveness. Establishing a shared vision may be an essential re-
faction, job recognition, and turnover intent (Allen & Meyer, 1990;
quirement for overcoming these difficulties (DeChurch & Mesmer‐
Mitchell et al., 2011; Tekleab et al., 2016). Within the context of team
Magnus, 2010; Inkpen & Tsang, 2016). Other scholars have also
diversity literature, team identity is most closely associated with the
shown that by creating shared mental models of the task, knowl-
CEM’s categorization path, where a strong team identity is indicative
edge sharing, and problem‐solving are enhanced (Bergman, Rentsch,
of less categorization and higher team cohesion (Hofhuis et al, 2012;
Small, Davenport, & Bergman, 2012; Rentsch & Klimoski, 2001).
Van Dick et al., 2008). Secondly, team performance, is defined as the professionals’
Based on these findings, we hypothesize that shared vision will reduce categorization processes, thereby enhancing the relationship
perception of how successful the team is in completing their tasks.
between functional diversity and team identification, as well as in-
Perceived performance has been shown to be a strong predictor of
creasing the likelihood of elaboration of task‐relevant information,
actual team performance (Brannick, Salas, & Prince, 1997). In con-
thereby enhancing the relationship between functional diversity and
trast with team identity, which is included to measure an affective
team performance and client satisfaction.
outcome, performance is included as a more concrete measure of effectiveness. It is likely to be affected by both the categorization and elaboration paths of the CEM (Van Knippenberg et al., 2004).
Hypothesis 1a‐c. Shared Vision moderates the relationship between Functional Diversity and (a)
Finally, although the main goal of community care teams is to
Team Identity, (b) Team Performance, and (c) Client
provide adequate care, client‐centered outcome measures are un-
Satisfaction, such that the relationship is more posi-
derrepresented in existing studies within such teams (Suter et al.,
tive when Shared Vision is high.
2009). In the present study, client satisfaction, defined as the degree to which professionals feel their interprofessional collaboration
A second important team process variable that was shown to af-
enhances the experience of their clients, is included as the third
fect functioning of care teams is Interaction frequency, defined as the
measure of team effectiveness. As an external extension of team
degree to which team members communicate regularly, and feel the
performance, this outcomes variable is also likely to be influenced by
obligation to attend meetings (Fay et al., 2006). It is well known that
both categorization and elaboration‐related processes.
regular interaction increases liking between individuals and enhances team identification (Tropp & Pettigrew, 2005; Tröster, Mehra, & van
1.5 | Moderating effects of team processes As mentioned earlier, the effectiveness of functionally diverse teams
Knippenberg, 2014). In the present study, we will examine whether interaction frequency may also play a moderating role between functional diversity and team identity, thus impacting the categorization
may be contingent on many other factors (Guillaume et al., 2017).
path. Furthermore, frequent interaction has been shown to open up
Several of the moderators mentioned above, such as task complex-
the possibilities of interprofessional teams to make use of their func-
ity, diversity beliefs, and identity threat (Van Dijk et al., 2012; Van
tional diversity to increase innovation (Fay et al., 2006), which suggests
Knippenberg & Haslam, 2007; Van Knippenberg et al., 2004), are all
it may also act as a moderator on the elaboration path. More evidence
applicable to this context. However, a recent review of literature,
for this relationship is provided by Monteiro, Arvidsson, and Birkinshaw
focusing specifically on care teams, points toward team process
(2008) who report that communicating regularly enhances knowledge
variables as the most relevant factors in determining their success
transfer, and leads to more in‐depth problem‐solving in teams. So far, it
(Supper et al., 2015). In the present study, we focus on three which
remains unclear whether this construct also acts as a moderator of the
have previously been shown to affect outcomes in teams within
relationship between functional diversity and productive team out-
similar contexts: shared vision, interaction frequency, and team
comes, but we predict that a similar influence will be observed.
reflexivity. Shared Vision is defined as the degree to which team members
Hypothesis 2a‐c. Interaction Frequency moderates
have a clear picture of, and agree upon, the goals of the team. Within
the relationship between Functional Diversity and (a)
the context of health and social care, Fay and colleagues (2006)
Team Identity, (b) Team Performance, (c) and Client
argue that having a shared vision provides the “glue” that holds an
Satisfaction, such that the relationship is more posi-
interprofessional team together. Other studies also confirm that
tive when Interaction Frequency is high.
problems that arise from the categorization path of the CEM (Van Knippenberg et al., 2004) may be circumvented by creating a shared
Finally, the present study examines whether the relationship be-
mental model of how the team should provide care to their clients
tween functional diversity and team effectiveness may also be con-
(see also Young et al., 2017).
tingent on Team Reflexivity, defined as the ability of a team to critically
Furthermore, in a team which consists of members with dif-
reflect on their own interactions, and adjust where necessary (West,
ferent professions, team goals may be more diffused, due to the
1996). Reflexivity has been shown to be useful for team performance
different functional frameworks within which the team mem-
in general but even more so in case of interprofessional collaboration
bers operate (Peltokorpi & Yamao, 2017). This could reduce the
(Schippers et al., 2015; Widmer, Schippers, & West, 2009). Literature
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HOFHUIS et al.
on the relationship between team reflexivity and categorization is
to test the hypotheses included 167 respondents (74.3% female;
scarce, but based on the notion that interpersonal contact and dis-
Mage = 44.3 years, SD = 10.8).
cussion of common goals is known to increase cohesion (Fay et al.,
The sample consisted of professionals with many different func-
2006; Mitchell et al., 2011) we also expect it to moderate the effects of
tional backgrounds, including, but not limited to, community nurses,
functional diversity on team identity. Furthermore, with regards to the
social workers, general health practitioners, physiotherapists, psy-
elaboration path, as functional diversity may increase miscommunica-
chologists, job coaches, youth counselors, financial advisors, and law
tion and inhibit the flow of interpersonal interaction, reflexivity may be
enforcement professionals.
necessary to overcome these difficulties and to establish high performance (Schippers, Edmondson, & West, 2014). By openly discussing and communicating about the way they cooperate, members of com-
2.2 | Measures
munity care teams may be able to make the best use of their different
The survey was written in Dutch, the main working language of the
functional backgrounds. Within the context of health and social care,
respondents. Formulations and sample items as provided below
team reflexivity has been reported to positively affect innovation and
were translated by the authors. Unless stated otherwise, all items
performance (Sheppard, Newstead, Di Caccavo, & Ryan, 2000). We
were measured on a 1–5 Likert scale, ranging from 1 (totally disa-
predict it will moderate the relationship between functional diversity
gree) to 5 (totally agree).
and team outcomes in similar fashion.
The first section of the survey asked respondents to indicate their own profession, from a list of 28 options. Next, they were asked to
Hypothesis 3a‐c. Interaction Frequency moderates
select, from the same list, which other professions were also repre-
the relationship between Functional Diversity and (a)
sented in their team. The total number of professions per team were
Team Identity, (b) Team Performance, and (c) Client
used as a raw indicator of functional diversity. Measuring diversity in
Satisfaction, such that the relationship is more posi-
this way is in line with Harrison and Klein’s (2007) concept of maxi-
tive when Team Reflexivity is high.
mum variety, in which the degree of diversity is highest when all members of the team are of a different professional group. This fits well with the context of interprofessional community care teams,
2 | M E TH O DS
because there are many professional categories, and no clear distinction between majority or minority groups. The main criticism of this type of diversity measure is its dependence on team size. To cir-
2.1 | Procedure and respondents
cumvent this, we divided the number of different professions by the total number of professionals in the team (Mean team size = 11.6;
Data for this study were gathered using a digital survey among health
Min = 4; Max = 45; SD = 7.1). This provided us with a relative mea-
and social care professionals who were working in community care
sure of functional diversity per team (M = 6.4; Min = 2.0; Max = 21.0;
teams in the Netherlands. As explained above, most of these profes-
SD = 3.4), which was used as a manifest variable in our analyses. Again,
sionals are employees of discipline‐based care organizations, and are
this applies well to the dynamic context of community care teams,
posted to different community care teams which also include mem-
which potentially involves members with many different professions
bers of other functional disciplines and organizations.
collaborating together, but where team size and composition are
Respondents were recruited through several channels. Firstly, a number of professionals were contacted through personnel
highly dependent on context and availability of professionals. It is important to note that, due to the nature of the recruitment
departments of participating care organizations, who agreed to
process, our respondents were working in many different commu-
send out invitations to their employees by e‐mail. Secondly, the
nity care teams around the Netherlands. Only in a few occasions
researchers directly contacted health and social care professionals
did more than one member of the same team complete our ques-
by phone and e‐mail. Those that were willing to participate were
tionnaire. As such, the descriptions of team composition given above
sent a digital invitation with a link to the survey. Thirdly, this link
are based on the response of individual team members only, not by
was also distributed through social media channels and digital
aggregating data from several team members.
newsletters of participating organizations, as well as through informal networking.
The survey included three outcome variables. Team identity was measured using four previously validated items (Allen & Meyer,
At the start of the survey, respondents were asked if they were
1990), including “The team I work for means a lot to me” (α = 0.83).
professionals working in primary health or social care, and within
Team performance was also measured using four previously validated
an interprofessional community care team. Those who answered
items (Bolino & Turnley, 2003), including “This teams fulfills its du-
negatively to either of these questions, were excluded from the
ties and responsibilities effectively” (α = 0.79). Client satisfaction was
sample, since they did not belong to the target group. In total, 186
measured using three original items constructed by the authors, spe-
members of the target group returned the questionnaire. Those
cifically intended to measure the perceived added value of the team
respondents who did not fully complete the questionnaire were
collaboration to client well‐being as reported by the professionals
also removed from the dataset. The final sample which was used
themselves. The items were “Our way of collaborating has added
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HOFHUIS et al.
6
value for the client,” “The existence of this team is good for the cli-
is recommended to calculate the Variance Inflation Factor (VIF),
ents in our community,” and “Clients are satisfied about the way this
by conducting single regression analyses between the predictor
team performs its work” (α = 0.80).
variables, and calculating the VIF from the resulting R 2 values.
Three moderators were included. Shared Vision was measured
A VIF > 3.0 is generally considered problematic (Dormann et al.,
using three items adapted from the Team Climate Inventory (TCI:
2013). In the present study, the VIF’s between the four independ-
Anderson & West, 1998), including “All of the members of this team
ent variables remain well below this threshold, the highest being
agree on the team’s goals” (α = 0.82). Interaction frequency was mea-
found between Interaction Frequency and Team Reflexivity (R 2 =
sured using three items from the TCI (Anderson & West, 1998) in-
0.12; VIF = 1.14).
cluding “The members of this team keep in regular contact with each
Furthermore, using AMOS 22.0 (Arbuckle, 2013), we tested for
other” (α = 0.72). Reflexivity was measured using three items from the
normality (multivariate kurtosis = 2.872; Mardia’s index = 1.632),
original team reflexivity scale by West (1996), including “Within this
which was within the boundaries for a multivariate analysis with our
team we regularly evaluate the way we work together” (α = 0.78).
sample size (Byrne, 2013).
Finally, to control for the effects of team tenure, we asked respondents to indicate how long their team had been working together. The mean team tenure was 32.2 months (Min = 0.5; Max = 120; SD = 32.6).
2.5 | Common method variance Because the present study makes use of self‐reported data from a single source, our results may be at risk of being influenced by common method bias (Podsakoff, MacKenzie, & Podsakoff, 2012). It has been
2.3 | Measurement model
argued that common method bias is less of a concern when conduct-
We conducted a confirmatory factor analysis to test the discrimi-
ing moderation analyses, and may in fact lead to an underestimation
nant validity of the scales for team identity, team performance, client
of the strength of interactions (McClelland & Judd, 1993). However,
satisfaction, shared vision, interaction frequency, and team reflexiv-
it is still considered good practice to test for its possible influence. In
ity, using structural equation modeling (AMOS 22: Arbuckle, 2013).
a comparison of three possible methods, Richardson, Simmering, and
First, a model was constructed in which all manifest variables predict
Stirman (2009) recommend using the CFA latent marker technique as
a single latent factor. This model was unidentified. Next, a 6‐factor
the most robust method for testing for common method variance. In
model was constructed using the individual items as observed vari-
line with their procedure, the measurement model was extended with
ables, predicting the six intended constructs as latent variables. This
a theoretically unrelated marker, with paths to each of its own indica-
model produced a satisfactory fit with the data (χ 2(155) = 283.354;
tors as well as with paths to the indicators of all other latent variables
CFI = 0.936; TLI = 0.931; RMSEA = 0.071). Based on these findings,
in the model. Next, we examined the change in model fit of the model
all six constructs can be included in our model as intended. Table 1
in which the marker’s item loadings are freely estimated, versus one in
displays the descriptive statistics and correlations of all variables
which they are constrained. The change in model fit was not significant
used in the study.
(Δχ 2 = 16.591; p = 0.06), which implies that our findings are unlikely to be influenced by common method variance.
2.4 | Assumptions Our analyses were at risk of being affected by multicollinearity, as evidenced by significant correlations between some of the predic-
2.6 | Team‐level variance Although the present study examines team‐level constructs, our
tor variables (see Table 1). Multicollinearity inflates the standard
analyses were limited by the way in which the data are structured.
errors of regression estimates, thus leading to unreliable estimates
Because of the nature of the recruitment, our respondents were not
of regression coefficients (Grewal, Cote, & Baumgartner, 2004).
organized in a small number of groups. In fact, our respondents were
To test for the degree of multicollinearity between predictors, it
members of almost as many different community care teams; only in a
TA B L E 1 Descriptive statistics and correlations Variables
α
1. Functional Diversity
M
S.D.
(2)
(3)
0.63
0.35
0.02
0.17*
0.08
0.04
–
0.43***
0.49***
0.40***
0.44***
0.50***
0.71***
0.57***
0.28***
0.43***
0.51***
0.38***
0.47***
–
0.29***
0.31***
2. Team Identity
0.83
3.89
0.52
3. Team Performance
0.79
3.52
0.68
4. Client Satisfaction
0.80
3.88
0.60
5. Shared Vision
0.82
3.50
0.76
6. Interaction Frequency
0.72
3.74
0.62
7. Team Reflexivity
0.78
3.82
0.61
Note. *p < 0.05, **p < 0.01, ***p < 0.001; n = 167.
–
(4)
–
(5)
(6) −0.06
–
(7) −0.05
0.48*** –
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HOFHUIS et al.
few cases did more than one member of the same team complete the
on team identity (b* = −0.29; p < 0.001), whereas when reflexivity is
survey. Nevertheless, we tested for the presence of team‐level vari-
high (+1 SD), the effect is positive (b* = 0.16; p = 0.010). This confirms
ance, using Hierarchical Linear Modeling (Raudenbush, Bryk, Cheong,
Hypothesis 3a.
Congdon, & Du Toit, 2011), but it was found to be insignificant (u0 = 0.12; ICC = 0.026). Therefore, our analyses do not benefit from multilevel modeling. As a result, the present study infers information on team‐level constructs through individual‐level measurements. The disadvantage of this, is that we cannot account for possible team‐ level effects on individual perception of our moderators or outcome variables. The advantage, on the other hand, is that there is no nested structure in the data, which negates the need to control for this.
3.2 | Team performance Figure 4 presents the model of the relationship between functional diversity and team performance, including the three moderators. Again, no main effect of functional diversity is found. Shared vision (b* = 0.46; p < 0.001) and team reflexivity (b* = 0.21; p = 0.005) display a positive main effect on team performance, interaction frequency does not.
3 | R E S U LT S The hypothesized moderating influence of shared vision, interaction frequency, and team reflexivity on the relationship between functional diversity and team effectiveness was tested through moderated structural equation modeling (MSEM), using latent interaction effects (Klein & Moosbrugger, 2000). In this case, MSEM is preferred over regular regression analyses, because the latter method does not take into account how manifest indicators predict latent constructs (Cortina, Chen, & Dunlap, 2001; Dawson, 2014). Ideally, all three moderators and outcome variables would be entered in a single structural model. However, fitting a model of the resulting com-
Shared vision does not display a significant interaction, so Hypothesis 1b is rejected. The moderating effect of Interaction frequency is significant (b* = 0.26; p < 0.001). As shown in Figure 5, when interaction frequency is low (−1 SD), functional diversity has no significant effect on team performance, whereas when interaction frequency is high (+1 SD), the effect is strongly positive (b* = 0.41; p < 0.001). This confirms Hypothesis 2b. Finally, there is no evidence for a moderating effect of team reflexivity, thus rejecting Hypothesis 3b. Finally, for team performance, a small positive relationship is also found with team tenure (b* = 0.13; p = 0.043), meaning that performance is higher in teams that have been working together longer.
plexity would require statistical power which exceeds that provided by the sample size of this study. Therefore, three separate models were constructed, one for each outcome variable. Each model includes seven predictors: the main effect of functional diversity, main effects of the three moderators, and interaction effects between functional diversity and each of the moderators. Age and gender of the respondents, as well as team tenure, were included as control variables in all the analyses presented below.
3.1 | Team identity Figure 1 presents the hypothesized model of the relationship be-
3.3 | Client satisfaction Figure 6 presents the model of the relationship between functional diversity and client satisfaction, including the three moderators. Again, no main effect of functional diversity is found. Shared vision (b* = 0.26; p < 0.001) and interaction frequency (b* = 0.23; p = 0.003) display a positive main effect, team reflexivity does not. The interaction effects of functional diversity with shared vision (b* = 0.24; p = 0.002), interaction frequency (b* = 0.37; p < 0.001), and team reflexivity (b* = 0.25; p = 0.001) are all found to be significant, meaning they moderate its relationship with client
tween functional diversity and team identity, and its moderators. No
satisfaction. As shown in Figure 7, when shared vision is low (−1
main effect of functional diversity is found. Shared vision (b* = 0.24;
SD), functional diversity has a negative effect on client satisfaction
p < 0.001), interaction frequency (b* = 0.20; p = 0.011), and team
(b* = −0.15; p = 0.017), whereas when shared vision is high (+1 SD), the
reflexivity (b* = 0.31; p < 0.001) all display a positive main effect on
effect is positive (b* = 0.33; p < 0.001). This confirms Hypothesis 1c.
team identity. The interaction effects of functional diversity with
As shown in Figure 8, interaction frequency has an even
shared vision (b* = 0.18; p = 0.018) and team reflexivity (b* = 0.15; p
stronger moderating effect. When interaction frequency is low
= 0.018) are also found to be significant, meaning they moderate its
(−1 SD), functional diversity has a negative effect on client satisfaction
relationship with team identity.
(b* = −0.28; p < 0.001), whereas when interaction frequency is high
As shown in Figure 2, when shared vision is low (−1 SD), functional diversity has a negative effect on team identity (b* = −0.23;
(+1 SD), the effect is positive (b* = 0.49; p < 0.001). This confirms Hypothesis 2c.
p = 0.002), whereas when shared vision is high (+1 SD), the effect is
Finally, as shown in Figure 9, the interaction between functional
positive (b* = 0.13; p = 0.021). This confirms Hypothesis 1a. For in-
diversity and team reflexivity displays a similar direction. When
teraction frequency, the moderation effect is not found to be signif-
reflexivity is low (−1 SD), functional diversity is negatively related to
icant, leading to rejection of Hypothesis 2a. For team reflexivity, the
client satisfaction (b* = −0.16; p = 0.009), whereas when reflexivity
interaction effect is quite pronounced. As shown in Figure 3, when
is high (+1 SD), a positive relationship is found (b* = −0.29; p < 0.001).
reflexivity is low (−1 SD), functional diversity has a negative effect
This confirms Hypothesis 3c.
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F I G U R E 1 Structural equation model of the influence of functional diversity, shared vision, interaction frequency, team reflexivity, and their interactions on team identity In sum, our findings confirm that shared vision moderates the ef-
may lead teams to perform better (Mitchell, Parker, Giles, & White,
fects of functional diversity on team identity and client satisfaction.
2010; Van Knippenberg et al., 2004), but the question remained under
Interaction frequency moderates the effects of functional diversity on
which conditions this may occur. The present research tested the influ-
team performance and client satisfaction. Team reflexivity moderates
ence of functional diversity on team identity, team performance, and
its relationship with team identity and client satisfaction. All moderation
client satisfaction within community care teams in the Netherlands, and
effects show a similar direction: in the absence of these team processes,
examined factors which may moderate these effects. In line with exist-
functional diversity displays negative or no effects on team outcomes,
ing literature, we specifically focused on three variables related to team
but when these processes are present, the effects are positive.
processes: shared vision, interaction frequency, and reflexivity (Fay et al., 2006; Supper et al., 2015; Xyrichis & Lowton, 2008).
4 | D I S CUS S I O N A N D CO N CLUS I O N As interprofessional collaboration becomes more commonplace in health and social care, both scholars and practitioners are searching for ways to make the most out of functionally diverse teams. Earlier research has shown that the presence of different functional backgrounds
F I G U R E 2 Simple slopes of the interaction effect of functional diversity with shared vision on team identity
4.1 | Overview of findings The first research question of the present study was whether or not functional diversity increases effectiveness of community care teams. Based on our results, we can state that that this is
F I G U R E 3 Simple slopes of the interaction effect of functional diversity with team reflexivity on team identity [Correction added on 20 August 2018, after first online publication: Figure 3 has been corrected.]
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F I G U R E 4 Structural model of the influence of functional diversity, shared vision, interaction frequency, team reflexivity, and their interactions on team performance vision, or when a team does not reflect regularly on their functioning, functional diversity leads to lower team identification. The notion that regular contact and positive team processes will enhance identification is well known (Mitchell et al., 2011), but this study is one of the first to confirm that it will moderate the relationship with functional diversity. For team performance, our study reveals similar effects. No overall relationship is found between functional diversity and team performance, but moderation analyses reveal that the benefits of diversity for productivity only come to the fore when team members interact frequently. Conversely, when there is less interaction, F I G U R E 5 Simple slopes of the interaction effect of functional diversity with interaction frequency on team performance [Correction added on 20 August 2018, after first online publication: Figure 5 has been corrected.]
functional diversity appears to inhibit team performance. That notion that interpersonal contact and communication are essential in creating the conditions for information elaboration is in line with existing research (Hofhuis, van der Rijt, et al., 2016). Contrary to expectations, shared vision and team reflexivity do not moderate the
indeed the case, but only under the right conditions. Across the sample as a whole, the relative number of different professions does not directly relate to team effectiveness. These findings are in line with earlier studies showing that the positive and negative effects of diversity may cancel each other out, thereby not resulting in a net effect on outcomes (Hofhuis, Van der Rijt et al., 2016; Kearney & Gebert, 2009; Van Knippenberg & Schippers, 2007). However, the added value of the present study is that possible moderators of these relationships were also examined, to test whether the effects of functional diversity may be contingent on team processes. When examining the effects of functional diversity on team identity, we find that respondents who work in a more diverse team also report higher team identity, but only when they also score high on shared vision and team reflexivity. When there is no shared
diversity–performance link. Both these team processes do, however, display strong main effects on performance, which implies they are essential in increasing performance of any team, regardless of the degree of functional diversity. Finally, for client satisfaction we again find no overall effects of functional diversity, but further examination reveals that here too, it strongly depends on team processes. Shared vision and interaction frequency display strong main effects on this outcome variable. More importantly, all three outcomes display moderating effects in the same direction as the ones explained above. Again, this confirms our prediction that team processes are essential for establishing positive outcomes in functionally diverse community care teams. Client satisfaction, although one of the most important outcomes of teams in this context, is often underrepresented as an outcome variable in scientific study. We have shown that even through an
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F I G U R E 6 Structural model of the influence of functional diversity, shared vision, interaction frequency, team reflexivity, and their interactions on client satisfaction
F I G U R E 7 Simple slopes of the interaction effect of functional diversity with shared vision on client satisfaction
F I G U R E 9 Simple slopes of the interaction effect of functional diversity with team reflexivity on client satisfaction use of such outcome measures in future studies on effectiveness of care teams. In sum, the present study adds to existing literature by systematically comparing the moderating effects of three team process variables on the relationship between functional diversity and team outcomes, including both internal (team identity, performance) and external (client satisfaction) constructs. As community care teams become more functionally diverse, having a shared vision, interacting frequently, and reflecting on collaboration will greatly enhance outcomes.
F I G U R E 8 Simple slopes of the interaction effect of functional diversity with interaction frequency on client satisfaction
4.2 | Limitations and future research As with all research, the present study has some limitations. The most important limitation is the fact it was unable to take into account
indirect subjective approach, it is possible to establish a measure of
team‐level variance. As such, most of the constructs mentioned in
client satisfaction which displays relationships with team outcomes
this paper should be interpreted as perceptions of individuals on
and team process variables, and explains extra variance over more
the functioning of their team as a whole. Replication of our find-
common measures of team performance. We highly recommend the
ings using team‐level measurements, thereby taking into account
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the hierarchical nature of such data, would be necessary to better understand the relationships which are reported above. Secondly, this study relies on self‐reported data. Therefore, as with all quantitative surveys, social desirability may be a concern. Special care was taken to guarantee anonymity of respondents, which may have minimized this problem, but replication of our findings using a different method would help confirm the reported relationships. For example, examining the influence of actual levels of interaction frequency, reflexivity, etc. using direct observations would be a logical next step in this line of research. Another limitation is that the results presented in this paper are based on cross‐sectional data, which means we cannot directly test for causal effects. Our conceptual model assumes an influence of functional diversity on team outcomes, since a reverse relationship seems illogical. However, the reported relationships
4.4 | Conclusions The findings presented in this paper shed new light on factors which may enable community care teams to unlock the benefits of functional diversity. By ensuring that professionals communicate regularly, spend time on defining a common goal for the team, and subsequently reflect on their collaboration, functional diversity may no longer lead to lower team effectiveness. In fact, when these conditions are met, functional diversity enhances team identification, performance, and client satisfaction. Paying close attention to the way professionals interact with each other in interprofessional community care teams and promoting team building activities may help these teams take the most advantage of their different backgrounds and provide better care. AC K N OW L E D G M E N T S
between team processes and outcomes are likely to be recipro-
This study was made possible through funding by the Dutch Taskforce
cal to a certain degree. Future studies could use longitudinal and/
for
or experimental designs to assess the causal nature of the rela-
Onderzoek SIA], on the project ‘Professioneel Samenwerken in de
tionships, e.g., by evaluating the effects of team interventions on
Wijk’ (Raak Publiek 2014‐01‐13M), which was awarded to Windesheim
outcomes. The present study has established quantitative evidence of
Applied
Research
[Nationaal
Regieorgaan
Praktijkgericht
University of Applied Sciences, Research Group Innovating with Older Adults, and Research Group Social Innovation.
the importance of team processes for the functioning of interprofessional community care teams. Further teasing out the nuances of how these factors affect team performance is essential to gain deeper understanding of the benefits and threats of functional di-
ORCID Joep Hofhuis
http://orcid.org/0000-0001-7531-8644
versity. For example, studies which evaluate the effectiveness of team interventions may shed new light on how shared vision or reflexivity can be enhanced in interprofessional community care teams, and how such teams can be equipped to meet their goals and objectives.
4.3 | Practical implications Based on the results of the study presented in this paper, we would recommend community care teams to specifically spend time on enhancing team processes. The authors recognize that most professionals in this specific target population are under considerable stress, and their motivation to spend extra time on team‐building and reflexivity is generally low (ten Den et al., 2015). However, considering the results presented above, it appears to be worthwhile to invest time and effort in establishing a shared vision, enhancing interaction between team members, and to schedule regular times for reflexivity (Gurtner, Tschan, Semmer, & Nägele, 2007). Many training programs exist that have been shown to enhance these team processes (Delise, Gorman, Brooks, Rentsch, & Steele‐ Johnson, 2010), many of which are specifically aimed at care practitioners (e.g., McLoughlin, Patel, O’Callaghan, & Reeves, 2018; Smits, Hofhuis, Rijsdijk, Mensen, & De Vries, 2016; Zwarenstein, Goldman, & Reeves, 2009). Although some energy needs to be spent to implement them, our results confirm that the net gain in terms of team effectiveness is great enough to warrant these efforts. We highly encourage health care organizations and team managers to invest in such programs.
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How to cite this article: Hofhuis J, Mensen M, ten Den LM, et al. Does functional diversity increase effectiveness of community care teams? The moderating role of shared vision, interaction frequency, and team reflexivity. J Appl Soc Psychol. 2018;00:1–14. https://doi.org/10.1111/jasp.12533
